C-sections 'do not affect how long a mum breastfeeds'

Having a Caesarean or instrumental birth does not appear to impact upon how long a mother breastfeeds, British research suggests.

A study of 2,000 mothers who received breastfeeding support also found little association with how soon after birth the baby was put to the breast.

What did have an impact was ethnicity, and the number of previous births, the study in BMC Pediatrics reported.

White mothers were 70% more likely to stop than non-White contemporaries.

The Department of Health recommends exclusive breastfeeding for the first six months of a baby's life, but the majority of UK mothers have abandoned it altogether by this point - giving the country one of the lowest breastfeeding rates in Europe.

There have been a series of measures aimed at increasing prevalence, from better support to a ban on any promotion of infant milks.

This latest study, conducted by the University of Manchester and East Lancashire Primary Care Trust, followed more than 2,000 mothers who all received breastfeeding help from the same peer support group, to enable a fair comparison of other factors.

Bucking the trend

On average these supported mothers were giving some breastmilk for 21 weeks, and half of them for more than 27 weeks, markedly higher than the national average. But there were differences between sub-groups.

What is really exciting about this research is the rates of breastfeeding - both exclusive and mixed - that have been achieved among all groups

Professor Mary Renfrew, infant feeding expert

White women tended to stop a number of weeks before non-white, with mothers of black and Indian ethnic origin breastfeeding the longest, closely followed by Pakistani.

But the relative economic status of the women made no difference, with the poorest as likely to continue or abandon breastfeeding as the wealthiest, nor did it matter whether the mothers were married.

Having an instrumental or Caesarean birth had no statistically significant impact on the duration of breastfeeding, contrary to some suggestions that a "non-natural" birth, possibly as a result of the analgesics used, may hamper feeding.

Also babies who were put to the breast within an hour of being born - as recommended by the World Health Organisation - were not breastfed any longer than those with whom breastfeeding was initiated within 48 hours.

Previous deliveries

The study did however find that the number of babies a mother had previously delivered impacted upon breastfeeding duration, with women having their third or fourth baby more likely to continue than those having their first.

The study's authors noted that while breastfeeding support was clearly important in mitigating a number of obstacles to prolonged feeding, there were other factors at play.

Dr Gabriel Agboado of East Lancashire PCT said: "The results suggest that infant feeding practices associated with maternal ethnicity and previous experience of having children may be more difficult to influence by peer support interventions.

"Peer support programs, particularly those in multi-ethnic settings, will need to identify the needs of their various client groups in order to appropriately support them to breastfeed longer".

Professor Mary Renfrew, who researches infant feeding practices, said: "We know that rates are higher among ethnic minority groups and that previous experience of breastfeeding has an effect on whether the mother does it again, and the study confirms this.

"But what is really exciting about this research is the rates of breastfeeding - both exclusive and mixed - that have been achieved among all groups. They are doing something right in this area, and it does seem to point to peer support, although there may be other factors involved.

"Tailored support is recommended for all mothers, but some places have been much more pro-active on this front than others. When people say you simply cannot get breastfeeding rates up, it's clear there are policies which can have an effect."

Sue Ashmore, head of Unicef's UK Baby Friendly Initiative said: "evidence shows that women are more likely to breastfeed if they are supported by someone who believes they can do it. This is the point of peer support programs.

"In the UK peer support work is varied, and therefore the results are varied. It is vital that robust monitoring and evaluation processes are in place so that strengths and weaknesses can be identified and addressed; this would lead to a more successful peer support programs nationwide."

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